Electronic medical record exchange system

ABSTRACT

An electronic medical record exchange system includes an electronic medical record appliance to interface with a first legacy electronic medical record system. An electronic medical record gateway server interfaces with the electronic medical record appliance and a second legacy electronic medical record system. The electronic medical record appliance and the electronic medical record gateway server communicate utilizing assigned doctor identifiers and patient identifiers that are different than assigned doctor identifiers and patient identifiers utilized by the first legacy electronic medical record system and the second legacy electronic medical record system.

FIELD OF THE INVENTION

This invention relates generally to electronic medical records. Moreparticularly, this invention relates to an electronic medical recordexchange system to provide universal message exchange between disparatelegacy electronic medical record systems.

BACKGROUND OF THE INVENTION

An electronic medical record is a collection of health information inelectronic form. The health information may relate to an individual'smedical history, medications consumed, allergies, immunization status,laboratory test results, radiology images, billing information and thelike. An electronic medical record (EMR) is sometimes referred to as anelectronic health record (EHR), electronic patient record (EPR) orcomputerized patient record.

EMRs are used to facilitate the automation and streamlining of theworkflow in health care settings. In addition, it is a goal to use EMRsto improve healthcare through evidence-based decision support, qualitymanagement and outcome reporting. While this is a laudable goal, itremains illusive in view of the capital costs, training costs andmaintenance costs of new systems.

Legacy systems are typically incompatible with one another. For examplea physician's office may have a first legacy system that is incompatiblewith a second legacy system at a hospital. Consequently, a doctor thatworks at both the physician's office and the hospital may not be able toexchange records between these two venues. In other words, the doctormay be able to use the first legacy system at the physician's office andthe second legacy system at the hospital, but the two systems operate inseparate silos and are otherwise not integrated.

A central data server may be used to store the different records, butthis represents an entirely new system with significant capital costs.In addition, there are challenges associated with normalizing disparaterecords and then loading them into a single repository. This solutionalso raises confidentiality concerns.

It is desirable to allow health care professionals to continue to usetheir legacy systems. However, it is also desirable to integrate suchlegacy systems with other legacy systems that have incompatible formats.For an integration to be practical, it must be relatively inexpensive.In addition, it must overcome challenges related to disparate doctoridentifiers and patient identifiers used in the different systems.Further, it must support message exchanges between legacy systems thatrequire different message formats. In addition, such a solution shouldprovide a comprehensive audit trail of messages that traverse betweenlegacy systems.

SUMMARY OF THE INVENTION

An electronic medical record exchange system includes an electronicmedical record appliance to interface with a first legacy electronicmedical record system. An electronic medical record gateway serverinterfaces with the electronic medical record appliance and a secondlegacy electronic medical record system. The electronic medical recordappliance and the electronic medical record gateway server communicateutilizing assigned doctor identifiers and patient identifiers that aredifferent than assigned doctor identifiers and patient identifiersutilized by the first legacy electronic medical record system and thesecond legacy electronic medical record system.

BRIEF DESCRIPTION OF THE FIGURES

The invention is more fully appreciated in connection with the followingdetailed description taken in conjunction with the accompanyingdrawings, in which:

FIG. 1 illustrates an electronic medical record exchange systemconfigured in accordance with an embodiment of the invention.

FIG. 2 illustrates an appliance or gateway configured in accordance withan embodiment of the invention.

FIG. 3 illustrates the establishment of master indices in accordancewith an embodiment of the invention.

FIG. 4 illustrates record audit trail and normalization operationsperformed in accordance with an embodiment of the invention.

FIG. 5 illustrates a record audit trail supplied in accordance with anembodiment of the invention.

FIG. 6 illustrates a record audit trail supplied in accordance withanother embodiment of the invention.

Like reference numerals refer to corresponding parts throughout theseveral views of the drawings.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 illustrates an electronic medical record (EMR) exchange system100 configured in accordance with an embodiment of the invention. Thesystem 100 includes a set of EMR appliances 102. Each EMR appliance 102is a hardware platform designed to provide an EMR computing resource. Anappliance is a closed and sealed system that is not serviceable by auser. Thus, it stands in contrast to a general purpose computer, where auser can modify the hardware configuration and load any type of softwaredesired. An appliance has a limited interface, usually a terminalconsole or web-based, to allow limited configuration operations. The EMRappliance is desirable because it effectively runs on its own, therebyreducing IT expenses. Automated back-up, software control andmaintenance are done behind the scenes, eliminating headaches likesoftware installation, conflicts and updates. The EMR appliance alsoprovides protection from viruses, hackers or other threats to security.Thus, the EMR appliance reduces initial capital costs and ongoingmaintenance costs.

Each EMR appliance 102 is connected to an EMR gateway server 104. TheEMR gateway server 104 is a general purpose computer implementingoperations of the invention. The EMR appliances 102 and EMR gatewayserver 104 operate as an EMR exchange system 100 to provideinteroperability with legacy EMR systems. For example, a first EMRappliance may be connected to a legacy physician's office EMR system106, while another EMR appliance 102 may be connected to a legacymedical clinic EMR system 108. The EMR gateway server 104 may beconnected to a legacy hospital EMR system. In general, an EMR appliance102 is used in connection with a relatively small legacy EMR system,while an EMR gateway 104 is used in connection with a relatively largelegacy EMR system. The system 100 may be configured with additional EMRappliances and EMR gateways 104.

The EMR exchange system 100 uses its internal components (102, 104) tocommunicate in a domain with common doctor and patient identifiers thatare different than the doctor and patient identifiers utilized in thelegacy EMR systems. The EMR exchange system 100 also provides anend-to-end audit trail of messages exchanged between legacy EMR systems.In addition, the EMR exchange system 100 transforms incompatible messageformats utilized by different EMR legacy systems to providecompatibility between the different EMR legacy systems.

FIG. 2 illustrates a computation device 200 configured in accordancewith an embodiment of the invention. The computation device 200 may beconfigured as an EMR appliance 102 or an EMR gateway server 104. In thecase of an EMR gateway server 104, standard server components are used,such as a central processing unit 202 and input/output devices 206connected by a bus. The input/output devices 206 may include a keyboard,mouse, display, printer and the like. A memory 208 is also connected tothe bus. The memory 208 includes executable instructions to implementoperations of the invention. In one embodiment, the memory 208 includesan exchange index module 210. The exchange index module 210 includesexecutable instructions to assign doctor and patient identifiers thatare used within the EMR exchange system 100. This allows the EMRexchange system 100 to efficiently identify and process doctor andpatient records within the system 100, while still being compatible withlegacy systems that use different doctor and patient identifiers.

The memory 208 also includes an audit trail module 212. The audit trailmodule 212 includes executable instructions to provide end-to-endtracking of a message passed through the EMR exchange 100, as discussedbelow.

The memory 208 also includes a message processing module 214. Themessage processing module 214 includes executable instructions totransform in incompatible message formats from different legacy systemsinto a format that can be used by different legacy systems, as discussedbelow.

The operations of modules 210, 212 and 214 are also implemented in eachEMR appliance 102. Thus, an EMR appliance 102 may have a similarconfiguration to device 200. However, the appliance 102 will typicallyomit the input/output devices 206. Further, the appliance 102 mayimplement its operations through an Application Specific IntegratedCircuit or other custom hardware instead of a general purpose centralprocessing unit. Regardless of the appliance configuration, it operatesin conjunction with the EMR gateway 104 to provide patient and doctoridentifiers, audit trail tracking and message processing. Theseoperations are distributed between an EMR appliance 102 and an EMRgateway 104, as discussed below.

FIG. 3 illustrates operations associated with assigning master doctorand patient identifiers in accordance with an embodiment of theinvention. The figure illustrates operations performed across variousmachines, including a legacy system, an EMR appliance 102 and an EMRgateway 104.

A legacy system, such as a system at a hospital or a clinic, includes aphysician and patient database. The identifier for a patient or aphysician at one legacy system (e.g., a hospital) could be differentthan the identifier at another legacy system (e.g., a clinic).

When the EMR appliance 102 is initially activated, it generates aregistration request 300. The registration request 300 initiates anaccess to a list of doctors 304 in a legacy system. The list of doctorsis then routed 302 to the EMR gateway 104. The EMR gateway 104 assigns amaster doctor identifier to each doctor on the list. This master doctoridentifier is used within the medical record exchange system 100. Aclinic identifier may also be assigned to the doctor so that a doctoroperating at different clinics can be uniquely identified andcoordinated with appropriate patients. The master doctor identifier isthen returned 308 to the EMR appliance 102. This causes the EMRappliance 102 to access 310 a patient list 312 within the legacy system.The EMR appliance 102 associates doctors and patient 314. Thereafter,the EMR appliance 102 assigns master patient identifiers 316 to eachpatient. Each master patient identifier is used within the EMR exchangesystem 100. Each master patient identifier is typically different thanthe patient identifier used in the legacy system.

From this point forward, any received EMR can be mapped from a legacysystem identifier to a master identifier utilized within the EMRexchange system 100. For example, an EMR message utilizing the doctoridentifier and patient identifier of legacy Physician Office EMR system106 is mapped to the master doctor identifier and master patientidentifier of the electronic medical record exchange system 100. Themaster doctor identifier and/or master patient identifier may then bemapped to a doctor or patient at legacy clinic EMR system 108.

Each master identifier is a unique value that has an associated list ofvalues for legacy systems. For example, the master doctor identifier hasa unique value. This unique value is associated with a list of doctoridentifiers used for the same doctor at different offices, clinics, orhospitals. The same approach is used with the master patient identifier.The term “master” indicates a prevailing identifier in the electronicmedical record exchange systems 100. However, it is not a “master”identifier across an entire EMR system. The use of a single “master”identifier across an entire EMR system implies centralized control,which is expensive and otherwise meets resistance for a variety ofreasons. In contrast, the invention provides a distributed system thatallows incompatible legacy systems to operate with one another.

If a message is received at the gateway 104, it is routed to anappliance 102 associated with a clinic or office that the doctorpractices at. In other words, the message is routed in accordance withthe master doctor identifier and clinic identifier. The appliance 102can then link the master patient identifier with the patient identifierused by the legacy system. Consequently, the EMR exchange system 100provides interoperability between legacy systems without synchronizationbetween different databases.

FIG. 4 illustrates audit trail processing performed in accordance withan embodiment of the invention. For example, a legacy system generateselectronic health information (EHI) 400, which is passed to the EMRappliance 102. The electronic health information may be in form of anEMR. Receipt of the EHI at the EMR appliance 102 initiates an audittrail 402. Optionally, the message may be normalized 404 forcompatibility with another legacy system. That is, a sender (e.g., ahospital) and a receiver (e.g., a clinic) may require different messageformats. The sender and receiver can ignore these incompatibilitiessince they are handled by the EMR exchange system 100. The EMR appliance102 or the EMR gateway 104 identifies the target system and thenevaluates data conformance rules utilized by the target system. Forexample, a sent message may be in HL7 2.3 form. However, the recipientrequires a 2.5 format. In this case, the appliance 102 invokes a scriptto convert the message from 2.3 to 2.5 before passing it on.Alternately, an HL7 message may have an outpatient code of “OP”. Thereceiving system may require a single character outpatient code. Theappliance 102 utilizes a script to provide the appropriate format.Alternately, a message may have a segment unrecognized by the targetsystem. In this case, the appliance deletes such a segment so that itcan be processed at the target system.

After any required normalization, the message is then exchanged 406 withthe EMR gateway 104. The message is audited 408 at the EMR gateway 104.At this point, the message would typically be directed toward anotherlegacy system through another exchange 410. An acknowledgement from thelegacy system may then be audited 412.

Alternately, an EHI 420 may be generated at another legacy system and beinitially passed to the EMR gateway 104. In this case, the EMR gateway104 initiates an audit trail 422. If necessary, the message isnormalized 444. The message is then exchanged 426 to the EMR appliance102, where it is audited 428. The message is then exchanged 430 toanother legacy system. An acknowledgement from the legacy system maythen be audited 432.

The audit trail allows for the tracking of the progress of messages. Theaudit trail can be used to certify that a message was properlyacknowledged by a target receiving entity. The appliance 102 and gateway104 may keep separate audit trails. Alternately, their audit trailinformation may be exchanged to produce comprehensive audit trailinformation.

The system generates a unique message identifier for each outgoingmessage. One message may be sent to several recipients. As a result,there is a 1-to-N mapping from an outgoing message identifier to anincoming message identifier. The unique identifier of the incomingmessage is associated with the outgoing message identifier forcorrelation.

An incoming message may not result in an outgoing message. In this case,a doctor identifier and clinic identifier may be used for auditpurposes. A legacy system may require a doctor to be of a fixed type(e.g., attending physician) to receive a message. The EMR exchangesystem 100 may transform a doctor to a fixed type (e.g., from referringto attending) to enable receipt of a message. The audit trail may beused to preserve the original doctor type.

FIG. 5 illustrates an audit trail formed in accordance with anembodiment of the invention. Window 500 displays message information,including status information, incoming message ID, outgoing message ID,message type, physician, patient and time. Window 502 illustratestracking of an individual message. In this example, a patient result isgenerated by a legacy system (Lutheran General) and is passed to EMRappliance 102 (Healthdock). The message is queued and then sent to theassociated clinic legacy system (EMR). The receipt of the message isthen acknowledged by the legacy system.

FIG. 6 illustrates a window with an audit trail that uses differentshading or coloring to represent the status of a message. For example,one shade may be used for receipt of a message, another for queuing amessage, another for sending a message, another for an initialacknowledgment and another for a final acknowledgment.

An embodiment of the present invention relates to a computer storageproduct with a computer readable storage medium having computer codethereon for performing various computer-implemented operations. Themedia and computer code may be those specially designed and constructedfor the purposes of the present invention, or they may be of the kindwell known and available to those having skill in the computer softwarearts. Examples of computer-readable media include, but are not limitedto: magnetic media such as hard disks, floppy disks, and magnetic tape;optical media such as CD-ROMs, DVDs and holographic devices;magneto-optical media; and hardware devices that are speciallyconfigured to store and execute program code, such asapplication-specific integrated circuits (“ASICs”), programmable logicdevices (“PLDs”) and ROM and RAM devices. Examples of computer codeinclude machine code, such as produced by a compiler, and filescontaining higher-level code that are executed by a computer using aninterpreter. For example, an embodiment of the invention may beimplemented using JAVA®, C++, or other object-oriented programminglanguage and development tools. Another embodiment of the invention maybe implemented in hardwired circuitry in place of, or in combinationwith, machine-executable software instructions.

The foregoing description, for purposes of explanation, used specificnomenclature to provide a thorough understanding of the invention.However, it will be apparent to one skilled in the art that specificdetails are not required in order to practice the invention. Thus, theforegoing descriptions of specific embodiments of the invention arepresented for purposes of illustration and description. They are notintended to be exhaustive or to limit the invention to the precise formsdisclosed; obviously, many modifications and variations are possible inview of the above teachings. The embodiments were chosen and describedin order to best explain the principles of the invention and itspractical applications, they thereby enable others skilled in the art tobest utilize the invention and various embodiments with variousmodifications as are suited to the particular use contemplated. It isintended that the following claims and their equivalents define thescope of the invention.

1. A de-centralized electronic medical record exchange system,comprising: a first electronic medical record appliance, separate frombut in electronic communication with a first legacy electronic medicalrecord system, where the first electronic medical record appliance isadapted to convert data in a first format from the first legacyelectronic medical records system to a common format shared with asecond electronic medical record appliance; said second electronicmedical record appliance in communication with the first electronicmedical record appliance and said second appliance separate from but inelectronic communication with a second legacy electronic medical recordsystem, where the second electronic medical record appliance is adaptedto convert data from the common format shared with the first electronicmedical record appliance to a third format used by the second legacyelectronic medical record system, wherein the first electronic medicalrecord appliance and the second electronic medical record appliance forma closed network that exchanges patient electronic medical record datausing the common format among said first and second legacy systemsutilizing assigned closed network doctor identifiers and closed networkpatient identifiers that are different than assigned legacy doctoridentifiers and legacy patient identifiers utilized by the first legacyelectronic medical record system and the second legacy electronicmedical record system; each of the first electronic medical recordappliance and the second electronic medical record appliance having alimited interface that inhibits user inputted operation after setup,said first and second electronic record appliances being dedicated,closed and sealed systems; and wherein the closed network doctoridentifiers and the closed network patient identifiers are unique withinthe closed network and distinct from the legacy doctor identifiers andlegacy patient identifiers utilized by the first legacy electronicmedical record system and the second legacy electronic medical recordsystem; and, wherein the closed network is operative with the firstlegacy electronic medical record system and the second legacy electronicmedical record system without synchronization of databases between thefirst legacy electronic medical record system and the second legacyelectronic medical record system.
 2. The de-centralized electronicmedical record system of claim 1 wherein the first electronic medicalrecord appliance maintains an audit trail of an electronic medicalrecord message exchanged between legacy electronic medical recordsystems.
 3. The de-centralized electronic medical record system of claim1 wherein the second electronic medical record appliance maintains anaudit trail of an electronic medical record message exchanged betweenlegacy electronic medical record systems.
 4. The de-centralizedelectronic medical record system of claim 1 wherein the first electronicmedical record appliance provides compatibility between legacyelectronic medical record systems utilizing different message formats.5. The de-centralized electronic medical record system of claim 1wherein the second electronic medical record appliance providescompatibility between legacy electronic medical record systems utilizingdifferent message formats.
 6. The de-centralized electronic medicalrecord system of claim 1, wherein the first electronic medical recordappliance processes a registration request by securing a doctor listfrom the first legacy electronic medical record system.
 7. Thede-centralized electronic medical record system of claim 6, wherein thefirst electronic medical record appliance routes the doctor list to thesecond electronic medical record appliance.
 8. The de-centralizedelectronic medical record system of claim 7, wherein the secondelectronic medical record appliance assigns the closed network doctoridentifiers.
 9. The de-centralized electronic medical record system ofclaim 8, wherein the second electronic medical record appliance returnsthe closed network doctor identifiers to the first electronic medicalrecord appliance.
 10. The de-centralized electronic medical recordsystem of claim 9, wherein the first electronic medical record applianceassociates patients of the first legacy electronic medical record systemwith the closed network doctor identifiers.
 11. The de-centralizedelectronic medical record system of claim 10, wherein the firstelectronic medical record appliance assigns the closed network patientidentifiers. 12-14. (canceled)